Providers Demographics Tab
The Demographics tab contains the provider name, address, and other profile information.
Field | Description |
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Last/ First/ Middle Names | Enter the name of the provider. It is very important that you only enter the provider's middle initial in the Middle Name field. If you enter an entire name in the Middle Name field (even though the field is labeled Middle Name instead Middle Initial), the application will take the last letter of the name you entered and enter it as the middle initial in box 17 of the HFCA 1500 form. |
Business/ Home/ Other1/ Other2 | Select the type of address information you want to enter for the provider. |
Address/ City/ State/ Zip/ Country/ County | The first space is for street number and name. The second space is for other address details such as suite number. If the ZIP code table is set up, you can enter the ZIP code, and the city, state, county, and country automatically display. |
Country | Select the drop-down arrow and select the applicable country. |
County | Select the drop-down arrow and select the applicable county. |
Phone/ Ext | The area code defaults in from the General Practice Preferences. Enter the phone number and extension. |
Fax | Enter the fax number, if applicable. |
Display As | Enter the name as you would like it to display in box 17 on the HCFA 1500 and within the NextGen® Enterprise PM application. The default is the name information from the Last Name and First Name fields. |
Spouse Name | Enter the name of the provider's spouse, if applicable. |
SSN | Enter the provider's Social Security number, usually populated through the billing system, although in some cases users have to populate it manually. |
Salutory Name | Enter the provider's name as it should appear in correspondence sent to him or her. |
Degree | Enter the medical degree held by the provider.
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E-Mail Address | Enter the E-Mail address of the Provider, if applicable. |
Fax Extras | If the provider has an automated system used to access the fax machine, enter the number used. |
Pager | Enter the pager number of provider, if applicable. |
Mobile Phone | Enter the mobile number of provider, if applicable. |